ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of chest pain (directly over the heart) after possibly bumping his chest. After a level-three E/M, the physician orders a single-view chest x-ray. The x-ray confirms that the patient did not have a cardiac episode; the notes, however, indicate that the patient had an angioplasty 12 years ago and the physician describes this consideration in the medical decision making. Do I need to note the patient's previous heart procedure on the claim?

Minnesota Subscriber

Answer: Although the patient did not have a heart attack, you should include a V code (V45.82, Percutaneous transluminal coronary angioplasty status) to represent the patient's past angioplasty.

Reasoning: The past angioplasty is part of the patient's medical history -- and because the patient reported for chest trouble, it likely affected the ED physician's medical decision making.

On the claim, report the following:

- 71010 (Radiologic examination, chest; single view, frontal) for the x-ray

- modifier 26 (Professional component) appended to 71010 to show that you are coding only for the service's professional portion

- 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99283 to show that the x-ray and E/M were separate services

- 786.51 (Precordial pain) appended to both 71010 and 99283 to represent the patient's presenting symptoms

- V45.82 appended to both 71010 and 99283 to represent the patient's past angioplasty.